Healthcare Provider Details

I. General information

NPI: 1114121217
Provider Name (Legal Business Name): DANIEL JOSEPH HANSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 E RIDGELINE DR
SOUTH OGDEN UT
84405-4976
US

IV. Provider business mailing address

1495 E RIDGELINE DR
SOUTH OGDEN UT
84405-4976
US

V. Phone/Fax

Practice location:
  • Phone: 801-399-3324
  • Fax: 801-394-2807
Mailing address:
  • Phone: 801-399-3324
  • Fax: 801-394-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7192033-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number7192033-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number7192033-1204
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number7192033-1204
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number7192033-1204
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number7192033-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: